Week 1 + 2: Medication Review Clinical Interventions PDF

TOPIC EXPLAIN FLASHCARDS **National medicines policy 2022** - The National Medicines Policy 2022 is a comprehensive framework that aims to ensure that Australians have access to safe, effective, and affordable medicines. The policy is built around four central pillars: Card 1: Fr...

TOPIC EXPLAIN FLASHCARDS **National medicines policy 2022** - The National Medicines Policy 2022 is a comprehensive framework that aims to ensure that Australians have access to safe, effective, and affordable medicines. The policy is built around four central pillars: Card 1: Front: What are the four central pillars of the National Medicines Policy 2022? Back: Equitable, timely, safe, and reliable access to medicines and medicines-related services; medicines meet the required standards of quality, safety, and efficacy; quality use of medicines and medicines safety; and collaborative, innovative, and sustainable medicines industry and research sectors. **Pillar 1: equitable, timely, safe and reliable access to medicines and medicine related services** - Ensure that individuals and the community can afford medicines and related services - Ensure that medicines are available in a timely manner - Ensure that medicines are safe and reliable Card 2: Front: What is the goal of the first pillar of the National Medicines Policy 2022? Back: To ensure that individuals and the community can afford medicines and related services, and that medicines are available in a timely manner and are safe and reliable **Pillar 2: medicines meet the required standards of quality, safety and efficacy** - Ensure that medicines meet the required standards of quality, safety, and efficacy - Ensure that medicines are manufactured, distributed, and dispensed in a way that maintains their quality and safety Card 3: Front: What is the goal of the second pillar of the National Medicines Policy 2022? Back: To ensure that medicines meet the required standards of quality, safety, and efficacy, and that medicines are manufactured, distributed, and dispensed in a way that maintains their quality and safety. **Pillar 3: quantity use of medicines and medicines safety** - Promote the safe and effective use of medicines - Minimise the risk of adverse events and medication errors - Ensure that healthcare professionals have the necessary skills and knowledge to prescribe and dispense medicines safely and effectively Card 4: Front: What is the goal of the third pillar of the National Medicines Policy 2022? Back: To promote the safe and effective use of medicines, minimize the risk of adverse events and medication errors, and ensure that healthcare professionals have the necessary skills and knowledge to prescribe and dispense medicines safely and effectively. **Pillar 4: collaborative, innovative and sustainable medicines industry and research sectors** - Foster a collaborative and innovative medicines industry that can respond to current and future health needs - Ensure that the medicines industry has the capability, capacity, and expertise to develop and supply safe and effective medicines - Encourage research and development in the medicines sector to improve health outcomes Card 5: Front: What is the goal of the fourth pillar of the National Medicines Policy 2022? Back: To foster a collaborative and innovative medicines industry that can respond to current and future health needs, ensure that the medicines industry has the capability, capacity, and expertise to develop and supply safe and effective medicines, and encourage research and development in the medicines sector to improve health outcomes. **Definitions of pharmaceutical care** - Pharmaceutical care is a patient-centred practice that aims to optimise the use of medications to improve health outcomes and quality of life. There are two prominent definitions of pharmaceutical care: Card 3: Front: What is the main focus of pharmaceutical care? Back: The main focus of pharmaceutical care is to optimize the use of medications to improve health outcomes and quality of life. **Helper and strand definition** - Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient\'s quality of life. - This definition emphasises the importance of pharmacists taking responsibility for the outcomes of drug therapy and working to improve patients\' quality of life. Card 1: Front: What is the definition of pharmaceutical care according to Hepler & Strand? Back: Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient\'s quality of life. **Pharmaceutical care network Europe (PCNE) definition** - Pharmaceutical care is the pharmacist\'s contribution to the care of individuals in order to optimise medicines use and improve health outcomes. - This definition highlights the role of pharmacists in optimising medication use and improving health outcomes, and emphasises the importance of collaboration with other healthcare professionals. Card 2: Front: What is the definition of pharmaceutical care according to PCNE? Back: Pharmaceutical care is the pharmacist\'s contribution to the care of individuals in order to optimise medicines use and improve health outcomes Card 4: Front: What is the role of pharmacists in pharmaceutical care? Back: Pharmacists play a crucial role in pharmaceutical care by taking responsibility for the outcomes of drug therapy, optimizing medication use, and working to improve patients\' quality of life. **Comprehensive medication management (CMM) defenition** - a patient-centred approach to optimising medication use and improving patient health outcomes. It is based on the work of the Patient-Centred Primary Care Collaborative (PCPC) and Drs. Robert Cipolle and Linda Strand. Definition: - CMM is defined as \"a patient-centred approach to optimising medication use and improving patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other health care providers.\" Card 1: Front: What is Comprehensive Medication Management (CMM)? Back: CMM is a patient-centered approach to optimizing medication use and improving patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other health care providers. Card 4: Front: Who is involved in Comprehensive Medication Management (CMM)? Back: CMM involves collaboration between the clinical pharmacist, the patient, and other healthcare providers. **Goal of CMM** - The goal of CMM is to \"get the medications right\" by ensuring that patients receive the right medications, at the right time, in the right dose, and for the right duration. Card 2: Front: What is the goal of Comprehensive Medication Management (CMM)? Back: The goal of CMM is to \"get the medications right\" by ensuring that patients receive the right medications, at the right time, in the right dose, and for the right duration. **Key principles of CMM** - Patient-Centred: CMM is focused on the patient\'s needs and preferences, and involves the patient in the decision-making process. - Collaborative: CMM involves collaboration between the clinical pharmacist, the patient, and other healthcare providers to optimise medication use and improve health outcomes. - Comprehensive: CMM considers all aspects of a patient\'s medication use, including prescription and over-the-counter medications, supplements, and herbal products. - Medication Optimisation: CMM aims to optimise medication use by ensuring that patients receive the most effective and safe medications for their conditions. Card 3: Front: What are the key principles of Comprehensive Medication Management (CMM)? Back: The key principles of CMM are patient-centered, collaborative, comprehensive, and medication optimization. **Optimise medication therapy management** - The diagram presents a conceptual framework for optimizing medication therapy management, highlighting the interconnectedness of four key components: Education, Practice, Research, and Policy & Systems. Card 1: Front: What are the four components of Medication Therapy Management? Back: Education, Practice, Research, and Policy & Systems **Medication therapy management: Education** - Focuses on educating healthcare professionals, patients, and caregivers about medication therapy management - Aims to improve knowledge, skills, and attitudes towards medication use Card 2: Front: What is the focus of the Education component? Back: Educating healthcare professionals, patients, and caregivers about medication therapy management to improve knowledge, skills, and attitudes towards medication use **Medication therapy management: practice** - Involves the application of medication therapy management principles in clinical practice - Includes activities such as medication review, monitoring, and counselling Card 3: Front: What is the focus of the Practice component? Back: Applying medication therapy management principles in clinical practice, including medication review, monitoring, and counselling **Medication therapy management: research** - Encompasses the generation of evidence to inform medication therapy management practices - Includes studies on medication safety, efficacy, and effectiveness Card 4: Front: What is the focus of the Research component? Back: Generating evidence to inform medication therapy management practices, including studies on medication safety, efficacy, and effectiveness **Medication therapy management: policy and systems** - Refers to the development and implementation of policies and systems to support medication therapy management - Includes regulatory frameworks, guidelines, and standards for medication use Card 5: Front: What is the focus of the Policy & Systems component? Back: Developing and implementing policies and systems to support medication therapy management, including regulatory frameworks, guidelines, and standards for medication use **Interconnectedness of diagram** - The diagram highlights the interconnectedness of the four components, suggesting that they are interdependent and influence one another - The overlapping areas between the components represent the integration of education, practice, research, and policy & systems in optimising medication therapy management Card 6: Front: What does the diagram suggest about the relationship between the components? Back: The components are interdependent and influence one another, requiring integration and collaboration to optimize medication therapy management **Cyclical process of diagram** - The circular arrangement of the components and the blue arrows indicate a continuous cycle of improvement - This suggests that medication therapy management is an ongoing process that requires ongoing education, practice, research, and policy & systems development Card 7: Front: What does the circular arrangement of the components and blue arrows indicate? Back: A continuous cycle of improvement, suggesting that medication therapy management is an ongoing process that requires ongoing education, practice, research, and policy & systems development **Concept of medication management review and pharmaceutical care: from drug to patient focus** - The diagram illustrates the evolution of medication management and pharmaceutical care, highlighting the shift from a drug-centred approach to a patient-centred approach. Card 1: Front: What is the main concept illustrated in the diagram? Back: The Concept of Medication Management Review / Pharmaceutical Care: from drug to patient focus **Stages of mediation management evolution** Medicine (Supply or Dispensing role) - Focuses on the supply and dispensing of medications - Emphasises the role of pharmacists in providing medications to patients Patient (Provision of service in collaboration with other health care professionals) - Focuses on the provision of services to patients in collaboration with other healthcare professionals - Emphasises the importance of teamwork and collaboration in patient care Patient focus - Quality Use of Medicines (QUM) - Focuses on the quality use of medicines to improve patient outcomes - Emphasises the importance of patient-centred care and the role of pharmacists in promoting quality use of medicines Card 2: Front: What are the three main stages in the evolution of pharmaceutical care shown in the diagram? Back: 1. Medicine (Supply or Dispensing role), 2. Patient (Provision of service in collaboration with other health care professionals), 3. Patient focus - Quality Use of Medicines (QUM) **Transition from drug centered to patient centered approach** - The diagram shows the transition from a drug-centred approach to a patient-centred approach through two green arrows - The first arrow leads from \"Medicine\" to \"Patient,\" indicating the shift from a focus on medications to a focus on patients - The second arrow points to the right side of the image, indicating the ultimate goal of patient-centred care Card 3: Front: How does the diagram show the transition in pharmaceutical care? Back: Through two green arrows moving from \"Medicine\" to \"Patient\" and then to \"Patient focus\" **Importance of collaborative care** - The diagram emphasises the importance of collaboration between healthcare professionals in patient care - The middle stage, \"Patient,\" highlights the provision of services in collaboration with other healthcare professionals Card 4: Front: What aspect of patient care is emphasised in the middle stage? Back: Provision of service in collaboration with other health care professionals **Ultimate goal of medication management** - The ultimate goal of medication management is patient-centred care, with a focus on quality use of medicines (QUM) Card 5: Front: What is the ultimate goal of medication management according to the diagram? Back: Patient focus - Quality Use of Medicines (QUM) **Abbreviations and acronyms used** - HMR / RMMR stand for Home Medicines Review / Residential Medication Management Review Card 6: Front: What do the abbreviations HMR / RMMR likely stand for in the context of medication management? Back: Home Medicines Review / Residential Medication Management Review **Evolution of pharmaceutical care concept** - The concept of pharmaceutical care evolves from a drug-centred approach to a patient-centred approach - The diagram illustrates the shift from a focus on medication supply to a focus on patient-centred care Card 7: Front: How does the concept of pharmaceutical care evolve according to the diagram? Back: It shifts from a drug-centred approach (supply or dispensing) to a patient-centred approach (quality use of medicines) **Australian model for home medicines review (HMR)** - The Australian Model for Home Medicines Review (HMR) is a process for reviewing and managing medications for patients at home. The process involves coordination between general practitioners (GPs), pharmacists, and patients. Card 6: Front: What does HMR stand for in this Australian healthcare model? Back: Home Medicines Review Card 7: Front: How many main steps are involved in the Australian Model for HMR? Back: Five steps **Steps in the HMR process** Identification of Consumer - The first step in the HMR process is to identify the consumer (patient) who requires a medication review. GP Referral to Patient\'s Preferred Community Pharmacy / Pharmacist - The GP refers the patient to their preferred community pharmacy or pharmacist. Pharmacist Visits Consumer at Home & Reviews Their Medicines - The pharmacist visits the consumer at home and reviews their medicines. Pharmacist Provides GP with an HMR Report - The pharmacist provides the GP with an HMR report. GP & Patient Agree on Medication Management Plan - The GP and patient agree on a medication management plan. Card 1: Front: What is the first step in the HMR process? Back: Identification of consumer Card 2: Front: After identifying the consumer, what does the GP do next in the HMR process? Back: Refers the patient to their preferred community pharmacy or pharmacist Card 3: Front: What action does the pharmacist take in the HMR process? Back: Visits the consumer at home and reviews their medicines Card 4: Front: What does the pharmacist do after reviewing the patient\'s medicines? Back: Provides the GP with an HMR report Card 5: Front: What is the final step in the HMR process? Back: GP and patient agree on a medication management plan **Conceptual framework for drug related problems (DRPs)** - The conceptual framework for DRPs provides a structured approach to identifying, classifying, and quantifying DRPs. The framework consists of four key components: Causes of/Contributing Factors for the DRP - Identifies the underlying causes or contributing factors that lead to the DRP - Examples: underdose, overdose, drug-drug interaction, precaution for drug use DRP: Drug Therapy Causes Harm or Drug Therapy is Not Working - Defines the DRP as a situation where drug therapy causes harm or is not effective - Examples: adverse drug reactions, ineffective treatment, medication errors Recommendations or Solutions to the DRP - Provides recommendations or solutions to address the DRP - Examples: decrease in dose, monitor blood levels, cease drug, add drug Card 1: Front: What are the four key components of the conceptual framework for DRPs? Back: Causes of/contributing factors for the DRP, DRP: drug therapy causes harm or drug therapy is not working, recommendations or solutions to the DRP, and classification and quantification of DRPs Card 2: Front: What are some examples of causes of/contributing factors for DRPs? Back: Underdose, overdose, drug-drug interaction, precaution for drug use Card 3: Front: What is the definition of a DRP? Back: A situation where drug therapy causes harm or is not effective Card 4: Front: What are some examples of recommendations or solutions to DRPs? Back: Decrease in dose, monitor blood levels, cease drug, add drug **Classification of DRPs** - DRPs can be classified into several categories, including: Adverse Drug Reactions (ADRs): - harmful or unwanted effects of a drug Medication Errors: - mistakes in the use of medications, such as wrong dose or wrong medication Ineffective Treatment: - drug therapy is not effective in treating the patient\'s condition Medication-Related Problems: - problems related to the use of medications, such as non-adherence or misuse Card 5: Front: What are some categories of DRPs? Back: Adverse drug reactions, medication errors, ineffective treatment, medication-related problems **Quantification of DRPs** - DRPs can be quantified using various metrics, such as: - Frequency: number of DRPs per patient or per medication - Severity: severity of the DRP, such as mild, moderate, or severe - Impact: impact of the DRP on patient outcomes, such as hospitalisation or death Card 6: Front: How can DRPs be quantified? Back: Frequency, severity, impact **Example scenario: Mr. Oas prescription for Celebrex 100mg** - Mr. OA presents with a new prescription for Celebrex 100mg. Upon reviewing his file, it is noticed that he has an allergy to sulfonamides recorded. Action: - Stop the dispensing process: Do not dispense the medication until the allergy is addressed. Consult with the prescriber: - Contact the prescriber to inform them of the allergy and discuss alternative treatment options. Assess the risk: - Evaluate the risk of an allergic reaction if the medication is dispensed. Provide patient education: - Educate Mr. OA on the potential risks associated with taking Celebrex 100mg given his sulfonamide allergy. Rationale: - Patient safety: The primary concern is the patient\'s safety, and dispensing a medication that may cause an allergic reaction is not acceptable. Professional responsibility: - As a healthcare professional, it is essential to take responsibility for ensuring the safe use of medications. Card 1: Front: What is the scenario presented in the example? Back: Mr. OA presents with a new prescription for Celebrex 100mg, and an allergy to sulfonamides is recorded in his file. Card 2: Front: What is the first action to take in this scenario? Back: Stop the dispensing process and consult with the prescriber. Card 3: Front: Why is it important to stop the dispensing process? Back: To ensure patient safety and prevent a potential allergic reaction. Card 4: Front: What should be discussed with the prescriber? Back: Alternative treatment options that do not pose a risk to the patient given their sulfonamide allergy. Card 5: Front: What is the importance of patient education in this scenario? Back: To inform the patient of the potential risks associated with taking Celebrex 100mg and ensure they understand the importance of safe medication use. **Example scenario: Vancomycin IVI 500mg Q6H for MRSA in a patient with reduced renal function** - While on a ward round at the local district hospital, a medication chart is reviewed, which states Vancomycin IVI 500mg Q6H for MRSA. However, it is noted that the patient has reduced renal function, with a creatinine clearance (CrCl) of approximately 35ml/min. Action: - Consult with the prescriber: Inform the prescriber of the patient\'s reduced renal function and discuss the need for dose adjustment. Assess the risk: - Evaluate the risk of vancomycin toxicity in the patient with reduced renal function. Recommend dose adjustment: - Suggest a dose adjustment to prevent vancomycin toxicity, such as reducing the dose or increasing the dosing interval. Monitor renal function: - Recommend regular monitoring of the patient\'s renal function to ensure that the dose adjustment is effective and safe. Rationale: - Patient safety: The primary concern is the patient\'s safety, and administering a medication that may cause toxicity in a patient with reduced renal function is not acceptable. Pharmacokinetics: - Vancomycin is primarily excreted by the kidneys, and reduced renal function can lead to increased serum levels and toxicity. Clinical guidelines: - Clinical guidelines recommend dose adjustment for vancomycin in patients with reduced renal function to prevent toxicity. Card 1: Front: What is the scenario presented in the example? Back: A medication chart states Vancomycin IVI 500mg Q6H for MRSA, but the patient has reduced renal function (CrCl=35ml/min). Card 2: Front: What is the first action to take in this scenario? Back: Consult with the prescriber to discuss the need for dose adjustment. Card 3: Front: Why is it important to assess the risk of vancomycin toxicity? Back: To prevent harm to the patient and ensure safe medication use. Card 4: Front: What is the recommended action to prevent vancomycin toxicity? Back: Dose adjustment, such as reducing the dose or increasing the dosing interval. Card 5: Front: Why is it important to monitor renal function in this scenario? Back: To ensure that the dose adjustment is effective and safe, and to prevent further toxicity. **Components of clinical interventions** - Clinical interventions involve identifying and addressing potential problems or issues related to medication use. The components of clinical interventions include: Finding (Problem) - Identifying a potential problem or issue related to medication use - Example: A potential drug-drug interaction between drug A and B Causes - Identifying the underlying causes of the problem - Example: The mechanism of action of drug A and B, patient factors, or other medications Consequences - Identifying the potential consequences of the problem - Example: Adverse effects, reduced efficacy, or increased risk of adverse events Recommendations - Providing recommendations to address the problem - Example: Dose adjustment, alternative medication, or monitoring Rationale - Providing a clear rationale for the recommendations - Example: Based on clinical guidelines, evidence-based practice, or patient-specific factors Card 1: Front: What is the first component of clinical interventions? Back: Finding (problem) Card 2: Front: What is an example of a finding (problem) in clinical interventions? Back: A potential drug-drug interaction between drug A and B Card 3: Front: What is the second component of clinical interventions? Back: Causes Card 4: Front: What is an example of a cause in clinical interventions? Back: The mechanism of action of drug A and B, patient factors, or other medications Card 5: Front: What is the third component of clinical interventions? Back: Consequences Card 6: Front: What is an example of a consequence in clinical interventions? Back: Adverse effects, reduced efficacy, or increased risk of adverse events Card 7: Front: What is the fourth component of clinical interventions? Back: Recommendations Card 8: Front: What is an example of a recommendation in clinical interventions? Back: Dose adjustment, alternative medication, or monitoring Card 9: Front: What is the fifth component of clinical interventions? Back: Rationale Card 10: Front: What is an example of a rationale in clinical interventions? Back: Based on clinical guidelines, evidence-based practice, or patient-specific factors End of lecture learning outcomes: - Describe the national medicines policy - Describe the process of medication management review - Conduct simple clinical interventions